Extreme Exertion Research Articles

Standardized Approach to Pediatric Post-COVID Syndrome and Its Impact on Children and Adolescents: A Perspective From a Tertiary Center.

Pediatric post-COVID syndrome (pPCS) affects a notable number of children. This study aims to describe its clinical manifestations, biopsychosocial impact and management strategies. A prospective, single-center study was conducted to analyze data of pPCS patients presenting to our institution between May 2021 and November 2022. Functional impact was evaluated by assessing school absenteeism and by using the Adolescent Depression Rating Scale (ADRS), Pediatric Quality of Life Inventory (PedsQL) and Fatigue Severity Scale. Among the 50 patients included [median age (interquartile range): 14.0 (12.9-15.8) years; females: 70%], the most common symptoms were extreme fatigue (84%), exertion intolerance (82%), orthostatism (66%), dyspnea (66%) and headache (66%); 25% had an abnormal Schellong test. Median (interquartile range) ADRS, PedsQL and Fatigue Severity Scale scores were 3.0 (1.0-5.0), 56% (49%-71%) and 45.0 (32.0-53.0), respectively. Sixty percent experienced partial (34%) or complete (26%) school absenteeism. The most common referrals to specialized consultations were child psychiatry (48%), pulmonology (46%), physiotherapy (36%) and an ear-nose-throat specialist (24%). Eighty percent had a typical form of pPCS, whereas 20% had a clinical presentation suggestive of a functional disorder triggered by COVID-19. The latter had more frequent thoracic pain (P = 0.012) and more referrals to pediatric neurology (P = 0.01), gastroenterology (P = 0.011), ophthalmology (P = 0.037) and child psychiatry (P = 0.035), but less to pulmonology (P = 0.014). School absenteeism and social withdrawal were also more common in this group, with more severe PedsQL and ADRS scores. pPCS is associated with a significant socio-educational burden that should be taken into account in medical, social and educational care.

Clinico-epidemiological Profile of Frostbite Cases in High Altitude Region of Northern India

Abstract Objectives: The objective of the study was to study the clinico-epidemiological profile of frostbite cases in high altitude region of Northern India. Study Design: This study involves a descriptive study. Materials and Methods: A descriptive study was undertaken in service hospitals situated in the northernmost region of India receiving frostbite cases from December 1, 2019, to Mar 30, 2020, to assess their clinico-epidemiological profile. A semi-structured questionnaire was designed comprising demographic characteristics and clinical and epidemiological characteristics of the frostbite cases. Frostbite cases were classified based on grades of injury and were studied for any association with age, physical activity, and temperature extremes. Results: A total of 29 cases of frostbite were reported during the study period with the majority of cases being <25 years of age. All cases were reported at altitudes of above 12,000 ft. and maximum cases gave a history of direct exposure to extreme weather conditions or other predisposing factors. The most common complaint at the onset of the symptoms was discoloration of the skin followed by swelling of digits and pain with most of the cases falling under first and second grade of injury. Protective clothing and footwear were adequate during induction/de-induction/stay in extreme climate regions. Conclusions: Exposure to extreme cold climates, high altitude, personal clothing, and physical exertion plays an essential role in the occurrence of frostbite cases as well as their severity. With the rising number of cases of frostbite, understanding of multiple factors which predisposes to frostbite injury is essential.

Dynamics of maximum oxygen consumption under extreme physical exertion in ski racers

Dynamics of maximum oxygen consumption under extreme physical exertion in ski racers

Cortisol and insulin behaviors during an ultramarathon event: are they real markers of extreme exertion?

The current work aimed to describe and compare the cortisol and insulin concentrations behavior and rate of perceived exertion (RPE) during a 115 km ultramarathon race. Nine ultrarunners (eight males) were evaluated six times (0, 37, 60, 76, 89 and 115 km). At each moment, saliva samples (for cortisol and insulin assessment) and RPE (CR10 scale) were collected. Statistical analysis included correlation, one-way repeated measure ANOVA, and Statistical Parametric Mapping to define discrete and continues changes and compare cortisol, insulin and RPE profiles. Our main findings revealed an early peak in cortisol and RPE, accompanied by a decline in insulin responses (402±49 min of the race, P<0.05). Cortisol and insulin only showed magnitude differences with inverse behaviors until ~6% (7 km) of the ultramarathon duration. Cortisol and RPE presented similar behaviors, rising from the beginning of the race and remaining elevated throughout the race (η2=0.91 and η2=1.0, P<0.001). Insulin levels decreased when the race started, remaining below 60% of baseline values from the midpoint to the end of the race (P=0.04). The study showed an imbalance in the catabolic/anabolic hormone profile during an ultramarathon race, with a prominence in catabolic state. It should be considered in the ultramarathon races preparation and participation due to its possible detrimental effect on the athlete's health.

A longitudinal assessment of heat exposure and biomarkers of kidney function on heat shock protein 70 and antibodies among agricultural workers

BackgroundExposure to extreme heat impacts millions of people worldwide and outdoor workers are among the populations most affected by hot temperatures. Heat stress induces several biological responses in humans, including the production of heat shock proteins (HSP) and antibodies against HSP (anti-HSP) which may play a central role in the body’s cellular response to a hot environment.ObjectiveThis longitudinal study investigated the impact of elevated temperatures and humidity on the presence of HSP70 and anti-HSP70 and examined relationships with markers of kidney function in an at-risk workforce under conditions of extreme heat and exertion in Guatemala.MethodsWe collected ambient temperature and relative humidity data as well as biomarkers and clinical data from 40 sugarcane workers at the start and the end of a 6-month harvest. We used generalized mixed-effects models to estimate temperature effects on HSP70 and anti-HSP70 levels. In addition, we examined trends between HSP70 and anti-HSP70 levels and markers of kidney function across the harvest.ResultsAt the end of the harvest, temperatures were higher, and workers had, on average, higher levels of HSP70 and anti-HSP70 compared to the beginning of the season. We observed significant increasing trends with temperature indices, heat index, and HSP70 levels. Maximum temperature was associated with HSP70 increments after controlling for age, systolic and diastolic blood pressure (β: 0.21, 95% Confidence Interval: 0.09, 0.33). Kidney function decline across the harvest was associated with both higher levels of anti-HSP70 levels at the end of the harvest as well as greater increases in anti-HSP70 levels across the harvest.ConclusionsThese results suggest that workplace heat exposure may increase the production of HSP70 and anti-HSP70 levels and that there may be a relationship between increasing anti-HSP70 antibodies and the development of renal injury. HSP70 holds promise as a biomarker of heat stress in exposed populations.

Exertional Rhabdomyolysis and Ultra-Trail Races: A Systematic Review Highlighting the Significant Impact of Eccentric Load

Exertional rhabdomyolysis (ER) is a condition where muscle breakdown occurs after intense and unaccustomed exercise in healthy individuals. It is characterized by muscle pain, weakness, and myoglobinuria, potentially leading to acute kidney injury and worsening the patients’ prognosis. Ultra-trail races (UT) necessitate high energy and extreme muscular exertion, which can result in significant muscle breakdown, leading to ER and elevated biomarkers such as creatine kinase (CK) and lactate dehydrogenase (LDH). These races involve longer durations and both uphill and downhill elevations, with the latter causing more muscle damage. This systematic review aims to analyse the effect of downhill elevation (at least 1000 m) in UT on muscle and liver damage biomarkers. We conducted a systematic review of four electronic databases (Pubmed, Web of Science, Scopus, and Sportdiscus) based on PRISMA guidelines for systematic reviews. We included a total of 15 articles out of 6670 published between January 2005 and March 2024. The total population sample included 348 subjects, comprising 294 men (84.48%) and 54 women (15.52%) with a mean age of 39.82 ± 6.89 years. Only one subject (0.28%) was diagnosed with ER. The median increase in CK post vs. pre was 5370.63 ± 7289.71%, LDH post vs. pre was 311.20 ± 164.4%, and liver damage biomarkers aspartate transaminase (AST) and alanine aminotransferase (ALT) obtained mean increases of 1009.94 ± 743.97% and 207.02 ± 92.84%, respectively. No liver injury cases were reported. These findings suggest that ER is often misdiagnosed in UT and may result in acute kidney injury under certain circumstances. Therefore, it is crucial to define and prepare the characteristics required for ultra runners to safely participate in these extreme races.

Accuracy and precision of multiple body composition methods and associations with muscle strength in athletes of varying hydration: The Da Kine Study

BackgroundAthletes vary in hydration status due to ongoing training regimes, diet demands, and extreme exertion. With water being one of the largest body composition compartments, its variation can cause misinterpretation of body composition assessments meant to monitor strength and training progress. In this study, we asked what accessible body composition approach could best quantify body composition in athletes with a variety of hydration levels. MethodsThe Da Kine Study recruited collegiate and intramural athletes to undergo a variety of body composition assessments including air-displacement plethysmography (ADP), deuterium-oxide dilution (D2O), dual-energy X-ray absorptiometry (DXA), underwater-weighing (UWW), 3D-optical (3DO) imaging, and bioelectrical impedance (BIA). Each of these methods generated 2- or 3-compartment body composition estimates of fat mass (FM) and fat-free mass (FFM) and was compared to equivalent measures of the criterion 6-compartment model (6CM) that accounts for variance in hydration. Body composition by each method was used to predict abdominal and thigh strength, assessed by isokinetic/isometric dynamometry. ResultsIn total, 70 (35 female) athletes with a mean age of 21.8 ± 4.2 years were recruited. Percent hydration (Body Water6CM/FFM6CM) had substantial variation in both males (63- 73%) and females (58- 78%). ADP and DXA FM and FF M had moderate to substantial agreement with the 6C model (Lin’s Concordance Coefficient [CCC] = 0.90-0.95) whereas the other measures had lesser agreement (CCC < 0.90) with one exception of 3DO FFM in females (CCC = 0.91). All measures of FFM produced excellent precision with %CV < 1.0 %. However, FM measures in general had worse precision (% CV < 2.0%). Increasing quartiles (significant p<0.001 trend) of 6CM FFM resulted in increasing strength measures in males and females. Moreover, the stronger the agreement between the alternative methods to the 6CM, the more robust their correlation with strength, irrespective of hydration status. ConclusionThe criterion 6CM showed the best association to strength regardless of the hydration status of the athletes for both males and females. Simpler methods showed high precision for both FM and FFM and those with the strongest agreement to the 6CM had the highest strength associations. Summary BoxThis study compared various body composition analysis methods in 70 athletes with varying states of hydration to the criterion 6-compartment model and assessed their relationship to muscle strength. The results showed that accurate and precise estimates of body composition can be determined in athletes, and a more accurate body composition measurement produces better strength estimates. The best laboratory-based techniques were air displacement plethysmography and dual-energy x-ray absorptiometry, while the commercial methods had moderate-poor agreement. Prioritizing accurate body composition assessment ensures better strength estimates in athletes.

Excited delirium syndrome

Mental health calls make up a large proportion of ambulance workloads, with paramedics responding to a wide range of presentations such as anxiety, depression, bipolar disorder, schizophrenia, and excited delirium syndrome. Excited delirium syndrome is an increasingly common presentation, characterised by extreme agitation and aggression in a patient with an altered mental status. Excited delirium is a potentially life-threatening condition, with generally non-specific symptoms. Common triggers of excited delirium syndrome are acute drug use, psychiatric illness, or abrupt cessation of antipsychotic medication. It occurs when there is excessive dopamine stimulation in the striatum, combined with acute exposure to catecholaminergic psychoactive substances. A history of schizophrenia, or bipolar disorder are known risk factors for excited delirium syndrome. While agitation and aggression, concomitant with an altered mental status are the hallmark of excited delirium, other medical conditions such as hypoxia, head trauma, hypoglycaemia, hyperglycaemia, and infection can produce similar symptoms, and need to be ruled out as causes. Safety is paramount in the management of excited delirium, with the use of physical and chemical restraint being commonplace. Rhabdomyolysis often occurs when the patient is able to exercise extreme exertion against the restraints and this should be minimised to prevent the risk of cardiac arrest.

V04-06 ROBOTIC ASSISTED TRANS-VESICOSCOPIC URETERIC REIMPLANTATION IN CHILDREN: SURGICAL ERGONOMICS RELATED TO MUSCULOSKELETAL SYMPTOMS

You have accessJournal of UrologyCME1 Apr 2023V04-06 ROBOTIC ASSISTED TRANS-VESICOSCOPIC URETERIC REIMPLANTATION IN CHILDREN: SURGICAL ERGONOMICS RELATED TO MUSCULOSKELETAL SYMPTOMS MS Ansari, Prabhu Karunakaran, Sanjoy Sureka, and Priyank Yadav MS AnsariMS Ansari More articles by this author , Prabhu KarunakaranPrabhu Karunakaran More articles by this author , Sanjoy SurekaSanjoy Sureka More articles by this author , and Priyank YadavPriyank Yadav More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted surgery has been reported to provide many benefits over open surgeries to the patient and surgeon. Many surgeons experience work-related pain and musculoskeletal symptoms. Neck strain, back strain/pain and lower extremity exertion have been reported up to 20-40% of the surgeons in open surgeries. We sought to evaluate the feasibly of robotic assisted trans-vesicoscopic ureteric reimplantation in children and surgeons' work-related musculoskeletal symptoms in comparison to open surgery METHODS: The children under 12 years of age with vesicoureteric reflux (VUR underwent open) (Group I) and vesicoscopic robotic assisted ureteric reimplantation (VRAUR) (Group II). All surgeries were performed by a single surgeon. For VRAUR the patient was placed in a dorsal lithotomy position. Four ports (Two 8-mm working ports were placed in a straight line drawn along the anterior superior iliac spine and one endoscopic [middle]) 12 mm (Intuitive Surgical, Sunnyvale, CA), was placed 2 cm above the same line and the fourth assistant port of 3 mm was placed 2 cm below the line. The surgeons related ergonomic parameters recorded in both the groups were generalised pain, neck and back strain/pain along with lower extremity exertion to surgeons (assessed as per visual analogue scale [VAS]). Success was defined as the absence of VUR on direct radionuclide cystogram at 12 weeks. RESULTS: The median age of the children was 4.5 and 5.1 in groups I and II respectively. Both the groups had 30 of patients each. The grades of VUR was comparable in both the groups. The VRAUR procedure could be accomplished in all the cases without any slippage of robotic ports or clashing of arms except in 2-year-old that without any conversion. The 2-yr-old child with bladder capacity of 150 cc posed little difficulty due to space restriction and slight clashing of arms that lengthened the procedure but could be completed successfully. The mean operative time was 95 (90-122) and 140 (115-160) minutes (p=0.029) in groups I and II respectively with a successes rate of 96.7 and 93.3 (p=0.031) respectively. The Surgeons’ musculoskeletal VAS scores recorded were substantially more in Group I as compared to Group II (p value 0.03, OR 3.9 [1.9-5.4]). CONCLUSION: Robotic assisted laparoscopic ureteral reimplantation is feasible and offers success rate comparable to open surgery. The surgical ergonomics related to musculoskeletal symptoms are more substantial in open surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e339 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information MS Ansari More articles by this author Prabhu Karunakaran More articles by this author Sanjoy Sureka More articles by this author Priyank Yadav More articles by this author Expand All Advertisement PDF downloadLoading ...

ВЛИЯНИЕ ЭКСТРЕМАЛЬНЫХ УСЛОВИЙ ПРОЖИВАНИЯ И ФИЗИЧЕСКИХ НАГРУЗОК НА ФОРМИРОВАНИЕ АДАПТИВНЫХ СДВИГОВ В РЯДЕ ФИЗИОЛОГИЧЕСКИХ СИСТЕМ ОРГАНИЗМА

The article presents a review of the literature, which analyzes the influence of extreme living conditions and physical exertion on the formation of adaptive shifts in a number of physiological systems of the body. The concept and essence of adaptation, its connection with human performance in extreme environmental conditions and intense physical exertion are considered. The main types of functional states of the organism are described. Information is provided that stressful situations caused by extreme conditions exert an excessive load on the system of psychophysiological self-regulation and cause emotional and physical stress. The successive stages of the formation of adaptive shifts are characterized: urgent and long-term adaptation, their characteristic features are given. Systemic, cellular and epigenetic mechanisms of long-term adaptation are considered. The influence of the directed training process on the functioning of the human body in extreme conditions is revealed

Boosting Construction Employees’ Performance Through Smart Ergonomic Moves

Abstract Musculoskeletal disorders (MSDs) are construction workers’ most prevalent occupational diseases due to awkward body posture, high repetition of work and vibration. The study sought to examine the different types of ergonomic moves that could improve construction workers’ performance. Findings show that majority of the workers were males and their trade groups cut across different trade groups (masonry, carpentry, plumbing, and electricals). There was a scarcity of civil engineers and quantity surveyors in almost all the construction firms. The most influential factors that contributed to musculoskeletal injuries among construction workers were extreme temperature, static posture and exertion of force at work. These factors have contributed to the loss of concentration and absenteeism at work, which have also led to delays in the execution of work. Further findings show that engineering control measures should be employed, and training and education should also be given to workers to prevent MSDs among employees to enable them to work smarter but not harder to improve their performance. Employers should include education and specific task training in the company’s policy for all newly employed personnel. Workers should also be monitored to ensure that they take a recess during the day’s work.

Analysis of Variations in the Basic Indicators of Mini Pigs under Extreme Physical Exertion

Extreme physical exertion (work to failure) was simulated in untrained mini pigs. The results of complete blood tests, lactate measurements and clinical urine analysis revealed variations in the basic parameters of animals similar to those observed in people after extreme exertion.

Vaccination as an immune system status optimization tool for the high-performance sports: review

Objective: consideration of the importance of vaccination as a preventive measure of support the athlets immunne system in conditions of extreme physical exertion and increased epidemic risks.Materials and methods: analysis of local and foreign dates of immunocorrection and vaccination problems.Results: the presented review provides an integral assessment of the transitory immunosuppression, developing by the intensive training and competitive activities — exercise-induced immunosuppression. These dates described as an “open window” syndrome and characterized by an increased risk of viral and/or bacterial infection with predominant damage of the upper respiratory tract and gastrointestinal tract. Widespread immunoprophylaxis provides an effective and relatively safe method of infectious control at risk groups including athletes.Conclusion: Vaccines of National Immunization Schedule and Epidemiological Immunization Schedule provide complex impact to the athletes immune status in wide variety of physical and psychological stresses. Vaccination increases the ability of specific and nonspecific resistance to infections that provide significant prevention of the “open window” syndrome.

Медицинская реабилитация в спорте высших достижений после реконструкции передней крестообразной связки коленного сустава

The professional activity of high performance, or elite sportsmen involves loads approaching extreme exertion, which often leads to injuries of the lower limbs. Anterior cruciate ligament (ACL) injury is one of the most common types of knee injuries. This study aimed to evaluate the effectiveness of a comprehensive rehabilitation program for athletes that underwent arthroscopic ACL reconstruction. The study involved 64 athletes aged from 17 to 31 years. Treatment group participants were offered a comprehensive medical rehabilitation program that included isokinetic training sessions on the TECNOBODY IsoMove biomechanical exercising machine; the sessions followed a purpose-designed method. The results of medical rehabilitation of the athletes were assessed through gait analysis done with a DIERS Motion 4D complex. The assessments took place 8 and 15 weeks after the reconstruction. At 8 weeks after the surgery, gait analysis parameters revealed no significant differences between the groups. Fifteen weeks after the reconstruction, when treatment group (TG) members were through all the isokinetic training sessions, the results were as follows: for the Stand Time parameter, the operated limb (OL) support deficit was 0.04% compared to the healthy limb (HL) support, and for the Single Limb Support parameter it was 3.71%, while in the control group (CG) that had no isokinetic training sessions the values were 12.44% and 18.55%, respectively. As for the Swing Time parameter, TG participants showed the deficit of HL transfer symmetry (relative to OL) of 3.99%, while the value of this parameter in the CG was 20.54%. The difference is significant, which proves the effectiveness of the developed isokinetic training method as part of the comprehensive medical rehabilitation program, the application of which resulted in faster recovery of muscle strength and compromised walking-associated support and locomotor functions in TG athletes.

РОЛЬ ФУНКЦИОНАЛЬНЫХ СИСТЕМ ОРГАНИЗМА В ПРОЦЕССЕ АДАПТАЦИИ К ФИЗИЧЕСКИМ НАГРУЗКАМ

This article reveals such an important problem as human adaptation to physical activity and its impact on the functional state of the body. Adaptation is the basis of evolution, the result of which is genetically fixed and inherited. The adaptation process includes urgent and long-term processes. The mechanisms of these processes must be considered from the standpoint of G.K. Anokhin. In the process of sports activities, the increase in working capacity is ensured by activating the relaxation mechanism of urgent adaptation. The high intensity of energy exchange under conditions of extreme physical exertion causes a progressive increase in aundose and the accumulation of metabolic intermediates in the body of an athlete. It has been shown that under conditions of physical stress, a multiple increase in the content of the main stress hormones in the blood and urine is observed. In relation to the process of adaptation to physical loads, the functional approach received an original interpretation in our studies regarding the concept of the locomotor (motor) functional system (LFS), which combines as components most of the systems classified according to anatomical and functional characteristics: central nervous, autonomic, neuroendocrine, cardiovascular, respiratory, neuromuscular and others. As a result of our research, it was found that the effect of an explosive increase in working capacity is provided by increasing this working capacity, by activating the relaxation mechanism of urgent mobilization of protection, the essence of which is to activate the inhibitory systems of the central nervous system, normalize the process of relaxation of skeletal muscles and significantly increase its speed during the interaction of the body with various adaptogenic factors. It was also found that under conditions of physical stress, there is a multiple increase in the blood and urine of the main stress hormones.

Of neurological disorders in extreme conditions and emergency situations

The review examines the features of neurological disorders that develop in a contingent of people staying in war zones, extreme conditions and emergency situations. The structure of combat injuries is currently dominated by shrapnel and mine-explosive head injuries, craniocerebral trauma, compression and concussion of the brain. Traumatic wounds and features of military service in conditions of high risk and extreme physical exertion are accompanied by asthenia, cognitive disorders and mental disorders of varying severity. Substantiated is the use of Cortexin in craniocerebral and combined combat injuries received by military personnel and civilians in the centers of hostilities; with asthenic and anxiety-depressive disorders, cognitive impairment, sleep disorders, as well as to increase the body's resistance to adverse and extreme effects.

Capture Myopathy in Avian Species: A Review

Capture myopathy, also known as exertional myopathy or exertional rhabdomyolysis, is a complication of capture that can render an animal unable to stand or walk after a capture event. The disease is commonly iatrogenic and associated with pursuit, capture or handling of avian or mammalian species. Clinical signs in birds include difficulty or inability to walk or stand, sternal recumbency or hock–sitting, ataxia, knuckling of the toes, pain, depression, tachypnea, trembling, and death. Renal signs, including myoglobinuria, are less common in avian species. The pathogenesis is related to extreme exertion resulting in anaerobic metabolism and metabolic acidosis. Typical changes seen on blood work are extreme elevations of CK and AST, indicators of muscle damage. Pathologic lesions seen in birds with capture myopathy are similar to those seen in mammals, however, cardiac and renal lesions are less common than in mammals. Treatment is difficult, prolonged, and often unsuccessful. Treatment components utilized in case reports include fluid therapy, vitamin E and selenium supplementation, anti-inflammatories, physical therapy, and muscle relaxants. Given the low success rate of treatment, careful planning of capture events and minimization of patient stress during handling are crucial in order to avoid capture myopathy and the necessity of treatment.

Pituitary Macroadenoma: A Case of Balanced Deficiencies

Abstract Introduction: Diabetes insipidus (DI) rarely occurs in pituitary tumors although some patients may develop DI following pituitary tumor resection. However DI is known to occur in patients with tumors metastatic to the pituitary or in infiltrative disorders of the pituitary gland. We are reporting a patient with a 2 cm pituitary macroadenoma whose DI was unmasked by glucocorticoid therapy. Case Presentation: A 61-year-old male with a history of non-functioning pituitary macroadenoma, incidentally discovered on imaging in 2015 and stable at 1.6cm for 4 years, was referred to endocrinology for interval enlargement of his macroadenoma. He had presented to primary care due to new headache during extreme physical exertion, but otherwise denied any symptoms such as vision loss, fatigue, decreased libido, weight loss, or urinary frequency. Repeat MRI indicated growth to 2.1cm in the suprasellar component, no cavernous sinus involvement, and abutting the optic chiasm. Laboratory results revealed new onset central hypothyroidism (FT4 0.21 ng/dL (ref 0.78-2.19) with triiodothyronine 68 ng/dL (ref 80-200) and TSH 1.61 mIU/L (ref 0.47-4.68), central hypogonadism (Testosterone Free 1.3 pg/mL (ref 6.6-18.1)) and concern for adrenal insufficiency with a cortisol of 4.4 mcg/dL. He was empirically started on hydrocortisone replacement until an ACTH stimulation test could be completed, and after 3 days instructed to begin low dose levothyroxine replacement. At close followup, patient revealed that he developed new hourly nocturia causing significant distress. An overnight water deprivation test yielded a serum sodium 152 mmol/L with a urine osmolality 191 mOsm/kg, both rapidly improving with intravenous desmopressin. Copeptin was 4.6 pmol/L. Discussion Diabetes insipidus occurring in pituitary tumors including macroadenomas is extremely rare. Secretion of AVP occurs in the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei, and the superior portion of the supraopticohypophyseal tract. AVP deficiency is most commonly due to damage to these areas either through neurosurgery or trauma, and more rarely tumors or infiltrative disease. However, glucocorticoid and thyroid replacement each may precipitate the development of diabetes insipidus. Well described in literature, glucocorticoid deficiency and hypothyroidism each independently impairs free water excretion. Low cortisol stimulates release of antidiuretic hormone, but this secretion is then inhibited by exogenous steroid replacement. Cortisol interferes with AVP signaling through unclear mechanisms either at the V2 receptor or post-receptor level, decreasing translocation of type 2 aquaporins and therefore reducing free water reabsorption. It is important to recognize that CDI can be unmasked after glucocorticoid or thyroid hormone replacement.

The role of therapeutic nutrition and dietary supplements in the prevention and treatment of osteoarthritis at the initial stages of the disease in military personnel

Аbstract. Factors predisposing to the development of osteoarthritis in military personnel are analyzed. The physical stress inherent in military labor, for example, in the airborne troops, creates a high load on the joints and can cause the early dismissal of military personnel from the ranks of the Armed Forces of the Russian Federation. Based on the pharmacodynamics of chondroprotectors (stimulation of chondrocyte function, cartilage tissue regeneration processes, inhibition of the synthesis of inflammatory mediators, etc.), it can be argued that they have a significant effect on the pathogenetic mechanisms of the development of osteoarthritis, i.e. the mechanism of action of chondrocytes is reduced to the suppression of catabolic and stimulation of anabolic processes in the joints. The main principles of therapeutic nutrition for osteoarthritis are, a decrease in calorie intake, limiting the amount of carbohydrates, animal fats and salt consumed. A balanced diet, including sufficient macro- and micronutrients, has a therapeutic effect in patients with complaints of joint pain, helping to restore the damaged structure of the elements of the musculoskeletal system. The inclusion of dietary supplements in the diets of patients with complaints of joint diseases ensures the intake of nutrients necessary for the synthesis of glycosaminoglycans. These factors accelerate the rehabilitation of patients after extreme physical exertion and injuries of the musculoskeletal system inherent in military labor. An analysis of the materials of a clinical study a comparative study of the effectiveness of the treatment of osteoarthritis of the knee joint at the initial stage of the disease with the help of a representative of the group of chondroprotectors Аrthra containing chondroitin sulfate, glucosamine and non-steroidal anti-inflammatory drugs, is carried out. The introduction of chondroprotectors as a means of preventing osteoarthritis in the diets of military personnel experiencing extreme joint loads will strengthen the ligamentous-articular apparatus by normalizing cartilage moisture saturation, inhibiting the action of proteolytic enzymes and stimulating the synthesis of glucuronic acid, which improves the elasticity of connective tissue.

Linkage of occupational history records and medical screening examinations as a tool for assessing the long-term health impacts of wildland firefighting

Background. Wildland firefighters (WFFs) work under intense and demanding conditions in the protection of human health, life, and property. Air pollutant exposures, heat, noise, disrupted sleep, emotional and psychological stress, and extreme physical exertion each may have short-term consequences for WFFs. Although countless population-based studies have established the long-term consequences of these exposures individually, to date little research has been devoted to their chronic effects in WFFs. The health and fitness of WFFs and the duration and intensity of their varied exposures combined with their limited use of personal protective equipment make WFFs a unique population in need of study. Methods. Occupational history as a WFF was assessed using Incident Qualification and Certification System (IQCS) responder records. These records contain information on specific fires to which a WFF was assigned, the duration of the assignment, and jobs for which a WFF is qualified and the number of times those jobs were performed. IQCS records were linked to Department of the Interior Wildland Fire Medical Standards Program medical screening examinations performed between 2014 and 2017. Results. Between 2014 and 2017, over 10,000 prospective and current WFFs completed comprehensive medical screening examinations to determine fitness for arduous duty firefighting. The median age was 33 years, and 85% of participants were male. Measured median systolic and diastolic blood pressures were 122 and 78 mm Hg, respectively, and 13% had an abnormal resting electrocardiogram. Forty-one percent of participants had available IQCS occupational history records.Conclusions. Preliminary analyses emphasized cardiovascular health among WFFs, and future work will investigate other health measures and their association with occupational history. The project establishes a framework for expanded studies of the occupational health risks linked to wildland firefighting, and findings have the potential to guide future screening and surveillance programs.